New York Times article: India Has Fewer AIDS Victims Than Thought

[Guest guest]

Dear Forum,

What are your thoughts about today's New York Times article in which

Ramadoss claims that India only has 2 or 3 million people living with HIV and

AIDS?

Joya Banerjee

e-mail: <joya@...>

India Has Fewer AIDS Victims Than Thought

By G. McNeil Jr.

The New York Times. NEW DELHI, June 7 - India, which has repeatedly been accused

of denying the size of its AIDS epidemic, probably has millions fewer victims

than has been widely believed, according to a new household survey that has not

yet been released.

If the results of the survey - conducted under international supervision with

American financing - are correct, India is no longer the world's supposed

leader, with 5.7 million people infected with the virus in the official United

Nations 2006 estimate; it would again rank behind South Africa with 5.5 million

infected people, and possibly behind Nigeria with 2.9 million.

Early analysis of the figures in the survey suggests that the number of infected

people in India is between 2 and 3 million, according to

several sources, including American epidemiologists who know the data

and the health ministry here.

" Everyone transiting through here says, 'This is a pandemic,' " Dr.

Anbumani Ramadoss, India's health minister, said in an interview here.

" But I am very confident that we will not turn into a generalized

epidemic. "

A nation's AIDS epidemic is considered " generalized, " meaning it is

spreading throughout the sexually active population, when more than 1

percent of people are infected. India's official rate has hovered for

years at 0.9 percent of its 1.1 billion people; the new survey suggests that it

may actually be as low as 0.3 percent.

That implies that India has managed to keep its epidemic more like that of the

United States, where the virus circulates mostly within high-risk groups rather

than generally in the population. In the United States, the prevalance rate is

0.6 percent.

In India's case, the high-risk groups are prostitutes and their clients,

especially truckers; men who have sex with men; and people who inject drugs,

especially in the northeastern part of the country near the border with Myanmar.

Some experts on AIDS surveillance techniques have been saying the same

thing for years, arguing that Indians do not have the same kind of

sexual networks that are common in southern and eastern Africa, in which both

men and women often have two or more occasional but regular sexual partners over

long periods of time. Also, outside of prostitution, " transactional sex " between

teen-age girls and older men in return for money, food or clothes is much less

common in Asia than in Africa.

Chin, a professor of epidemiology at the University of California at

Berkeley, has argued that the typical way of estimating AIDS prevalence rates -

sampling the blood of pregnant women who come to urban health clinics and the

blood of high-risk groups - greatly

exaggerates national estimates.

He has been vindicated by more recent surveys, paid for by the United

States, that take blood samples in randomly chosen households in rural

and urban areas.

One of those, called the National Family Health Survey, produced India's new

figures. Such surveys, country by country, have led the United Nations to

gradually reduce its world estimates of the total number of people infected.

" This is a replay of what happened in Kenya, " Halperin, an expert on AIDS

infection rates at the Harvard School of Public Health, said of the India

report.

When Kenya was more carefully surveyed in 2004, Dr. Halperin said,

estimates of its prevalence rate were more than halved, to 6.7 percent

from the 15 percent that the U.N. AIDS agency had estimated in 2001.

But Dr. Halperin said that AIDS-fighting agencies have such a stake in

portraying the epidemic as an approaching Armageddon that they are

hesitant to make significant downward revisions in estimates.

India's survey was finished last year, but Avahan, an AIDS group here

financed by the Gates Foundation, refused to discuss the figures before their

formal release, which has not been scheduled.

" If the total number of cases in the world is half of what you've been

saying, that's a bitter pill to swallow, " Dr. Halperin said. " So every

year they lower the numbers a little bit, and retroactively change the

estimates of what it used to be. It's sort of Orwellian. "

In Africa, infection rates range as high as 30 percent. South Africa's

is about 22 percent, and that figure is considered relatively accurate

because the epidemic is older there than in India, and full population

surveys have been conducted.

Claims in recent years by prominent experts that India was in denial

about the scale of its AIDS problem have become a sore point for Indian health

officials.

Feacham, until recently the executive director of the Global

Fund to Fight AIDS, Tuberculosis and Malaria, said in early 2005, when

South Africa was thought to have slightly more cases, that " the official

statistics are wrong - India is in first place. " He warned that India's epidemic

could shoot up to African levels, wiping out the surging economy and leaving a

nation of orphans.

But S.Y. Quaraishi, then head of India's National AIDS Control

Organization, took offense, calling such projections " technically

incorrect and misleading. "

Holbrooke, president of the Global Business Coalition on

HIV/AIDS said in a 2006 interview disparaged contentions by Indian

leaders that their country would not follow Africa's path, and compared their

political courage unfavorably to that of China's leaders.

And in 2002, when Bill Gates visited India to donate $100 million to

fighting its epidemic, the country's health minister at the time,

Satrugan Sinha, accused him of " spreading panic among the general

public " by suggesting that cases could reach 25 million by 2010.

Given the new survey results, Dr. Ramadoss, the current health minister, was

asked if India was owed any apologies. All he wanted, he replied, was " that the

world acknowledge the efforts India is making. "

Among them, Dr. Ramadoss said, was the $2 billion it is spending to

fight the disease, the 75,000 people who now receive free antiretroviral

treatment, the 2,000 centers around the country that provide sex education and

condoms to sex workers and clients, and the 3,600 free testing centers.

India sends government workers to hand out condoms outside theaters

showing pornographic films, even though the films are illegal. It has

created a government condom brand called " Dipper, " a play on the the

advice painted on the backs of many large trucks, " Use Dipper at Night, " meaning

that following drivers should switch to low-beam headlights.

" India is glaringly not in a denial phase, " Dr. Ramadoss said, adding

that he was grateful for the pressure on his country from critics

because it had forced the country to move faster. " We need to work with the

Global Fund, not contradict each other. "

Anjali Gopolan, executive director of the Naz Foundation (India) Trust, which

runs an orphanage and fights stigmatization of AIDS victims, said she was

skeptical of any estimate as low as 2 million. But whatever the correct figure

turns out to be, she said, " the infection is here, and we have a huge burden -

we are a very sexually active culture, contrary to what the politicians want to

project. "

AIDS is still a disease that carries tremendous stigma in India. In

recent weeks, newspapers have carried reports of an AIDS patient left on the

street outside a hospital to die, of five infected children expelled from

school, and of a woman beaten to death by her in-laws, who feared she would

infect the family.

http://www.nytimes.com/2007/06/07/world/asia/07cnd-aids.html?hp